Field Services Group - Take 5 Checklist

Field Services Group - Take 5 Safety Audit

• Conducted on

  Date

• Prepared by

• Job Description

• Location
  Address

• Document No.

Stop and Think of potential HAZARDS for YOU and YOUR CO-WORKERS AT RISK - What controls have been put in place

• Is a current Construction Safety Plan available for this job?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Have all personnel been inducted to this site?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Do I / we have the correct PPE for the job?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Does the traffic control on this site protect your safety?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Does everyone on site have a construction safety induction card?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Is all the plant and equipment within current test and tag requirements?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Can I / we come into contact with Overhead or Underground hazards?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Can I / we fall onto, into or from anything?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Can I / we be injured by nearby activities or can my activities injure others nearby?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Are all personnel competent to perform the task required?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Can something fall onto to me or can I / we cause something to fall onto someone else?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Can I / we strain or over exert myself?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Can I / we slip or trip on anything?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Can I / we be injured by being caught in or between anything?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Can weather conditions, work environment or poor lighting affect job safety?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Can I / we come into contact with or be exposed to Hazardous Substances, Dangerous Goods or stored energy?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Is the site secure from unintentional entry?

  Safe

  At Risk

  N/A

• What control measure has put in place?

• Controlled Risk Rating

  Red

  Yellow

  Green

• Comments

• Site photo if required

  Media

• Signature

  Sign